Aims and scope The Annals of Esophagus (Ann Esophagus; AOE; ISSN: 2616-2784) is an international, peer-reviewed, open access journal focusing on basic and clinical research in all fields pertaining to the esophagus. In addition to esophageal cancers, Barrett's esophagus, gastroesophageal reflux disease, achalasia, hiatal hernias, esophagitis, congenital esophageal disease, esophageal diverticulum, esophageal perforation, benign esophageal neoplasms, and other rare esophageal malignancies are in the scope of AOE. The Annals of Esophagus is indexed and covered by Web of Science [Emerging Sources Citation Index (ESCI)], and received its latest impact factor of 0.7 for the year 2025. All submissions and review processes of AOE are conducted electronically to expedite the reviews and publication process. To best serve global authors and readers, AOE will spare no effort to minimize the duration of review and publication processes whilst maintaining the highest standards of each, and will maintain innovative efforts to meet readers’ need. AOE welcomes submissions of Original Research (full length and brief reports), Review Articles, Case Reports, Technical Articles with videos, and Editorials. For descriptions and length requirements of each article type, please refer to the journal’s Author Instructions. AOE is published by AME Publishing Company, with support from Wolters Kluwer (the journal content will be made available on Wolters Kluwer Health’s Lippincott and Ovid platforms). Indexing and Archiving Annals of Esophagus is indexed and covered by Web of Science [Emerging Sources Citation Index (ESCI)] Scopus Google Scholar Ovid Digital Preservation Portico Information for Authors AOE is a member of Committee on Publication Ethics (COPE) and it follows the Committee on Publication Ethics (COPE)'s guidelines and the ICMJE recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journal. Manuscripts submitted must be original work of the author(s) and must not be published previously or under consideration for publication elsewhere. Submission Turnaround Time In-house review: 1-3 weeks. External peer review: 1-3 months. Publication Ahead of Print: within 1 month after being accepted (with APC payment received). Formal publication: within 1-3 months after being accepted (with APC payment received). Original Articles are listed as priority. Publication Schedule Published continuously from Jan. 2018 to Dec. 2019, AOE now follows a quarterly publication model (March, June, September, December). Open Access Statement This journal is a peer reviewed, open access journal. All content of the journal is published under the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0). All articles published open access will be immediately and permanently free for everyone to read, download, copy and distribute as defined by the applied license. Free access and usage Permitted third party reuse is defined by the CC BY-NC-ND 4.0 license. 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Example of statements in published articles: https://actr.amegroups.org/article/view/8875; https://med.amegroups.org/article/view/8358/html. Contact with Editorial Office Kathy Zhao, Corresponding Editor, Annals of Esophagus Email: aoe@amegroups.com Phone: +86 20 66355775 Publisher information AOE is published by AME Publishing Company Address: Hong Kong branch office: Flat/RM C 16F, Kings Wing Plaza 1, NO. 3 on Kwan Street, Shatin, NT, Hong Kong, China. Updated on July 10, 2026
Long-term swallowing function following chemoradiotherapy for locoregionally advanced esophageal cancer: a retrospective cohort study
Background: Though the ESOPEC and MATTERHORN trials shifted the standard of care for resectable locally advanced esophageal adenocarcinoma to peri-operative FLOT and immunotherapy and esophagectomy from the CROSS regimen of neoadjuvant chemoradiation (CRT) followed by esophagectomy, patients who are ineligible for FLOT or surgery, decline standard of care, or have squamous cell carcinoma continue to standardly receive radiation. Strictures and/or dysphagia are common toxicities of esophageal CRT and can require procedural intervention. We examine rates of toxicity in a cohort receiving CRT +/− esophagectomy to identify incidence and drivers of swallowing toxicity. Methods: We conducted a retrospective single-institution cohort study of patients with T3–T4 or node positive, nonmetastatic adenocarcinoma or squamous cell carcinoma of the esophagus who received curative-intent CRT +/− esophagectomy between 2005 and 2013. Long-term swallowing function was assessed by the need for subsequent procedures, based on Current Procedural Terminology (CPT) codes for endoscopy with dilation and/or stent placement or feeding tube placement. Incidence rate ratios (IRRs) were determined using negative binomial regression modeling rates (number of subsequent swallowing procedures after treatment per person-time). Results: We assessed 103 consecutive patients; 77.0% of patients had a dysphagia score ≥1 at baseline, and 27.2% of patients had an esophageal stent in place during CRT. Most patients received 50.4 Gy in 28 fractions and 44.7% of patients received surgery after CRT. The median follow-up after completion of CRT was 70.1 months (95% confidence interval: 46.9–83.5 months) for living patients. At least one swallowing procedure was performed in 33.0% of patients (range, 1–20) after completion of curative treatment. The cumulative incidence of any local recurrence was 24%. On multivariable negative binomial regression patients with local recurrence [incidence rate ratio (IRR) 6.27, P=0.001] and squamous cell histology (IRR 5.12, P=0.04) were more likely to have higher rates of swallowing procedures after treatment, while patients who had an initial Karnofsky performance status (KPS) ≤80 (IRR 0.33, P=0.047) had lower rates of swallowing procedures. Conclusions: We demonstrate, in a real-world dataset, high rates of swallowing procedures in populations receiving curative intent CRT with or without esophagectomy. About one-third of patients received these procedures, a rate consistent with a dose-dependent relationship when contextualizing with other literature. Further work is needed to optimize the management of these patients, both to define optimal oncologic management and to optimize swallowing function in survivorship.
Efficacy and safety of definitive chemoradiotherapy for locoregional recurrence of esophageal squamous cell carcinoma following surgery, predominantly after neoadjuvant chemotherapy
Background: Esophageal squamous cell carcinoma (ESCC) recurs in approximately 50% of patients after surgery, and the prognosis remains poor. Local treatments, such as definitive chemoradiotherapy (dCRT), may have curative potential even after locoregional recurrence. This retrospective study evaluated the efficacy and safety of dCRT for locoregional recurrence of ESCC after neoadjuvant chemotherapy followed by surgery. Methods: This was a single-center, retrospective study conducted at a tertiary care center. We included consecutive patients with ESCC who developed locoregional recurrence after radical surgery and subsequently received dCRT between 2015 and 2020. Efficacy outcomes included complete response (CR) rate, progression-free survival (PFS), and overall survival (OS). Safety outcomes included early and late adverse events. Results: Twenty-five patients were analyzed. Median age was 70 years, and 20 patients (80%) were male. The site of recurrence was the mediastinal lymph nodes in 24 patients (96%). Treatment regimens included 5-fluorouracil (5-FU) and cisplatin plus radiotherapy in 23 patients (92%), S-1 plus radiotherapy in 1 patient, and 5-FU and nedaplatin plus radiotherapy in 1 patient. The overall CR rate was 52%. Median PFS was 9.66 months [95% confidence interval (CI): 5.59–not available (NA)], and 2-year PFS rate was 33.1% (95% CI: 14.5–53.1%). Median OS was 28.8 months (95% CI: 17.7–NA). Early adverse events of grade 3 or higher were leukopenia in 3 patients (12%), neutropenia in 3 (12%), thrombocytopenia in 1 (4%), and febrile neutropenia in 2 (8%). No grade 3 or higher late adverse events were observed. Conclusions: In patients with ESCC, dCRT for locoregional recurrence after neoadjuvant chemotherapy followed by surgery may allow for long-term survival in selected cases, with minimal severe adverse events.
Changes in esophageal physiology following weight loss interventions: a narrative review
Background and Objective: The prevalence of obesity is increasing, leading to renewed interest in medical, surgical and endoscopic interventions to promote weight loss. We aimed to explore available evidence regarding consequences of bariatric interventions to improve understanding of impact on esophageal function. Methods: Online databases (PubMed, Google Scholar) were systematically searched for English language studies published through December 31, 2025 that reported esophageal physiologic changes following bariatric interventions. Key Content and Findings: Obese individuals have higher likelihood of objective gastroesophageal reflux disease (GERD) and its complications compared to the non-obese. Diet and exercise reduce esophageal acid exposure time (AET), risk for erosive esophagitis and other GERD complications. Glucagon-like peptide 1 receptor agonists (GLP 1RAs) modestly increase risk of reflux disease, as well as erosive esophagitis, esophageal strictures and Barrett’s esophagus (BE). Among bariatric interventions, laparoscopic sleeve gastrectomy (LSG) increases risk of de novo GERD, with decreased lower esophageal sphincter tone and function, while Roux-en-Y gastric bypass (RYGB) reduces risk of reflux and can be offered to patients with pre-existing GERD. Esophageal hypomotility and achalasia-like syndromes are rare consequences of both LSG and RYGB. Obstructive syndromes can also be seen with laparoscopic adjustable gastric banding (LAGB), where the band may need to be deflated or removed. Endoscopic sleeve gastroplasty (ESG) has a more favorable post-procedure GERD profile compared to LSG. Other bariatric interventions including gastric balloons also promote GERD, but less objective data are available. Conclusions: Bariatric interventions impact esophageal physiology and symptoms, understanding of which can provide direction while planning these interventions. The risk of objective GERD and its complications decreases with diet and exercise while GLP-1RAs increase risk for GERD. Bariatric interventions produce measurable changes in esophageal physiology. LSG reduces lower esophageal sphincter (LES) resting pressure and raises intragastric pressure, resulting in elevated AET and de novo GERD; risk may be lower with ESG. In contrast, RYGB reduces AET, making it the preferred revision surgery for post-LSG patients with GERD. As newer bariatric interventions are developed and studied, understanding distinct esophageal physiologic consequences of each is essential for individualized patient counseling, appropriate procedure selection, and optimizing post-operative surveillance and management.
Endoscopic evaluation and management of early esophageal squamous cell carcinoma: a clinical practice review
Esophageal squamous cell carcinoma (ESCC) remains a major global health burden despite declining incidence in several regions. Early-stage ESCC, defined as neoplastic lesions confined to the mucosa or with minimal submucosal invasion, offers a unique opportunity for curative, organ-preserving treatment. Accurate assessment of invasion depth is central to patient selection, as the risk of lymph node metastasis (LNM) increases substantially with deeper mural involvement. Lesions limited to the epithelium or lamina propria generally carry minimal metastatic risk and are suitable for endoscopic treatment, whereas invasion into the muscularis mucosa (MM) or superficial submucosa requires careful individualized evaluation because of increasing nodal risk. For lesions with negligible or low metastatic potential, endoscopic resection (ER) techniques, including endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), remain the cornerstone of management. ESD, in particular, enables en bloc resection of larger lesions and provides accurate histopathological staging, resulting in lower local recurrence rates compared with EMR. Advances in image-enhanced endoscopy, including narrow-band imaging (NBI) and magnifying endoscopy (ME), have significantly improved lesion detection, delineation, and prediction of invasion depth. Endoscopic ultrasonography and cross-sectional imaging also contribute to staging and therapeutic planning in selected patients. Following resection, histopathologic evaluation of margin status, lymphovascular invasion (LVI), and depth of invasion guides decisions regarding surveillance, additional endoscopic therapy, chemoradiotherapy, or esophagectomy. In this review, we discuss preoperative evaluation, lesion selection, ER outcomes, and adjuvant therapeutic strategies for superficial ESCC. We also address procedure-related complications, including bleeding, perforation, and post-ESD strictures, along with current approaches for prevention and management. Finally, we explore ongoing challenges and future directions, including risk-stratified treatment algorithms, artificial intelligence (AI)-assisted endoscopic assessment, and evolving minimally invasive therapeutic approaches aimed at improving oncological outcomes while preserving quality of life.
Current status of conversion therapy after multidisciplinary treatment in initially unresectable advanced esophageal cancer: a narrative review
Background and Objective: Conversion therapy (CT) for initially unresectable esophageal cancer (EC) has emerged as a potential curative strategy. However, clinical evidence remains heterogeneous. This narrative review aimed to evaluate the current evidence, surgical indications, and clinical outcomes of CT, including conversion surgery (CS), in the era of potent systemic therapies. Methods: A literature search was conducted in PubMed for English-language literature prior to December 2025 to identify relevant original articles, clinical trials, and retrospective studies. We focused on the key evidence regarding induction chemotherapy, chemoradiotherapy, and recent immunotherapy in the context of CS. Key Content and Findings: For cT4b disease, definitive chemoradiotherapy or induction chemotherapy using intensive multi-drug regimens [e.g., docetaxel + cisplatin + 5-fluorouracil (DCF)] shows promising R0 resection rates. In cM1 disease, particularly with distant lymph node metastasis, CS may offer long-term survival for exceptional responders, although significant selection bias exists. The integration of immunochemotherapy (CheckMate 648, KEYNOTE-590, RATIONALE-306) has significantly improved systemic control, but its specific impact on surgical morbidity and long-term outcomes in CT requires further validation. Conclusions: Evidence for CT in initially unresectable EC is increasing, and R0 resection can yield favorable outcomes. However, it remains unclear whether CT is superior to continuing initial treatments. Further studies are warranted to establish the definitive role of CT.
Achalasia unveiled: a narrative review from pathophysiological mechanisms to modern diagnostic approaches
Background and Objective: Achalasia is a rare primary oesophageal motility disorder characterised by impaired relaxation of the lower oesophageal sphincter (LOS, also termed LES) and absent peristalsis, resulting in oesophageal outflow obstruction and significant impairment of quality of life. Despite advances in understanding its pathophysiology and diagnostic modalities, significant knowledge gaps persist. This narrative review aims to provide an overview of current understanding of pathophysiological mechanisms and modern diagnostic approaches for achalasia, integrating recent evidence from the Chicago Classification (CC) version 4.0 and emerging diagnostic technologies. Methods: We performed a literature search using PubMed, Scopus, Web of Science databases, Cochrane Library and manual reference searching from January 2015 to November 2025. Search terms included MeSH terms (“Oesophageal Achalasia”, “Oesophageal Motility Disorders”, “Manometry”) and free-text terms (achalasia, high-resolution manometry, Chicago Classification, pathophysiology, diagnosis). We included original articles, systematic reviews, meta-analyses, and clinical guidelines published in English. Key Content and Findings: The pathophysiology of achalasia involves selective loss of inhibitory neurons in the myenteric plexus, driven by predominantly cell-mediated immune mechanisms, with possible antibody-mediated contributions. Genetic predisposition, particularly HLA-DQβ1 associations, and viral triggers contribute to disease development. In the diagnostic process, it is important to rule out pseudo achalasia, a condition in which mechanical obstruction, frequently caused by infiltrating cancer, imitates primary achalasia. High-resolution manometry (HRM) remains the gold standard for diagnosis, with the CCv4.0 providing refined criteria for three distinct achalasia subtypes based on integrated relaxation pressure (IRP) and oesophageal body pressurisation patterns. Functional lumen imaging probe (FLIP) and timed barium oesophagram (TBE) are complementary tools that improve diagnostic accuracy, especially in cases where the results are unclear. Conclusions: Accurate diagnosis of achalasia requires integration of clinical presentation, endoscopic evaluation, HRM, and supportive testing. Understanding the pathophysiological basis and proper subtype classification is essential for optimising therapeutic outcomes. Future research should focus on identifying biomarkers for early diagnosis, elucidating the triggers of autoimmune neuronal destruction, and developing personalised treatment approaches based on disease phenotype.
Minimally invasive Ivor-Lewis esophagectomy for diffuse esophageal diverticulosis: a case report with video-vignette
Background: Mid-thoracic and lower-third esophageal diverticula are rare clinical conditions manifesting with dysphagia and regurgitation. In case of dysphagia endoscopic dilation of the esophagogastric junction may be employed to alleviate distal esophageal outflow resistance in patients unsuitable for surgical intervention. Laparoscopic or thoracoscopic diverticulectomy, with or without myotomy, may be considered for symptomatic patients fit for surgery. Diffuse esophageal diverticulosis (DED), however, is exceedingly rare, and its diagnostic evaluation and therapeutic management may be considerably more challenging than those of isolated esophageal diverticula because of the extensive structural involvement of the esophageal body. With the aim of illustrating the diagnostic assessment and therapeutic decision-making in this rare condition, we report a case of severe symptomatic DED treated by minimally invasive Ivor-Lewis esophagectomy. Case Description: A 74-year-old man presented with long-standing worsening dysphagia that evolved into absolute intolerance to oral intake, postprandial vomiting, and significant over six-month weight loss (14% of body weight). Upper endoscopy and contrast swallow study demonstrated DED characterized by multiple large, partially confluent diverticula involving the mid-thoracic and distal esophagus, causing marked tortuosity, contrast stasis, and delayed esophageal emptying. Upper endoscopy and computed tomography excluded malignancy. Given the severity of symptoms and extent of disease a minimally invasive Ivor-Lewis esophagectomy with Orringer anastomosis was performed. The postoperative course was uneventful. At 12-month follow-up the patient was asymptomatic with no dysphagia or regurgitation. Conclusions: Esophageal diverticula are rare and often associated with motility disorders. Although most patients are asymptomatic or respond to conservative management with endoscopic dilation, severe cases may lead to malnutrition, aspiration pneumonia, and disabling dysphagia with severe weight loss. Standard surgery addresses the diverticulum and the underlying motility disorder. However, in DED with significant esophageal structural damage, limited procedures may be ineffective. In carefully selected, physiologically fit patients, esophagectomy may represent an option. This case demonstrates that minimally invasive esophagectomy can achieve meaningful symptom relief and quality of life improvement.
Synchronized dual-ventilator technique and trans-cervical repair of tracheo-broncho-gastric fistula after pharyngo-laryngo-esophagectomy and mediastinal tracheostomy: a surgical technique
Tracheo-broncho-gastric fistula (TBGF) post total pharyngo-laryngo-esophagectomy (PLE), mediastinal tracheostomy and gastric pull-up (GPU) is a rare but life-threatening complication, with reported incidence and mortality rate up to 3% and 64.3%, respectively. Such low-seated fistula in patients with apical pleural scarring precludes conventional thoracic access. The challenge is in securing ventilation whilst ensuring adequate exposure for surgical repair. We describe an open, curative, trans-cervical repair technique. A 60-year-old with prior pulmonary tuberculosis, underwent curative manubrial resection, PLE and GPU for Stage IV pharyngo-esophageal squamous cell carcinoma (SCC). Patient completed adjuvant chemoradiotherapy and remained in disease remission, tolerating oral diet. Six-months later, he presented with recurrent aspiration pneumonia, post-prandial honking cough and weight loss. Bronchoscopy and gastroscopy demonstrated a 3 cm fistula between the distal trachea extending to right main bronchus (RMB) orifice and stomach staple-line (Wang Type II). The superior edge of the fistula was 1cm from the tracheostome opening; contrast computed tomography (CT) scan confirmed the endoscopic findings and presence of bilateral lung-field consolidation. Endoluminal stenting was unsuitable; trans-thoracic repair was not feasible; extra-corporeal membrane oxygenation (ECMO) was deemed too high-risk. Trans-cervical repair with synchronized dual-ventilator anaesthesia—one endotracheal tube (ETT) is placed in the left main bronchus (LMB) via the mediastinal tracheostome, and a second ETT is placed in the RMB via a temporary bronchotomy distal to the fistula; each connected to its own ventilator and synchronised for bilateral lung ventilation during operation. The gastric defect is closed primarily and reinforced with vastus lateralis muscle of the free anterolateral thigh (ALT) flap, whilst the ALT skin island reconstructs the resected postero-lateral tracheal wall and overlying chest wall skin. TBGF was successfully repaired without complications. Endoscopy one-month post-operation confirmed wound healing, and a widely patent trachea and RMB. Pneumonia improved. The patient was discharged at 2-month post-operation on oral feeding. Trans-cervical repair with synchronized dual-ventilator anaesthesia is feasible and offers a safer alternative to single-tube ventilation or ECMO for selected patients with TBGF. Temporary bronchotomy may provide immediate airway protection. Early diagnosis, multidisciplinary planning and referral to specialised centers are essential for successful long-term outcomes.
Does cervical ultrasound still matter after PET-CT in esophageal cancer staging?
Excessive water intake and gastroesophageal reflux disease: rationale for a research agenda